- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $3,683.00 / $7,500.00
| Facility | | $682.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.45 / $5,375.10 / $8,492.60
| Facility | | $3,383.45 | $5,375.10 | $8,492.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.85 / $207.85 / $207.85
| Facility | | $207.85 | $207.85 | $207.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.86 / $132.05 / $1,145.00
| Facility | | $32.86 | $132.05 | $1,145.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.81 / $678.00 / $1,582.00
| Facility | | $167.81 | $678.00 | $1,582.00 |